Challenging Alveolar Hemorrhage Complicating Pneumonia After Liver Transplantation: A Case Report

Transplant Proc. 2018 Dec;50(10):4046-4049. doi: 10.1016/j.transproceed.2018.06.017. Epub 2018 Jun 22.

Abstract

Alveolar hemorrhage is a life-threatening clinical syndrome often initially thought to be atypical pneumonia. Association with hematopoietic stem cell transplantation is well studied, but not with solid organ transplantation. We report a case of a 54-year-old woman presented with fever and shortness of breath on the third posttransplant day after deceased donor liver transplantation. Imaging studies showed diffuse bilateral pulmonary infiltrates and a positive sequential bronchoalveolar lavage test was revealed during bronchoscopy. Cytomegalovirus antigenemia was present in 8/200,000 white blood cells; Aspergillus galactomannan and Pneumocystis jirovecii were also present. However, only Aspergillus hyphae were found in the sputum culture. Management strategy aimed to treat underlying infections, provide adequate respiratory support, and control inflammation. We proposed that diffuse alveolar hemorrhage should be considered as differential diagnosis in early pulmonary complications after liver transplantation. Early diagnosis and aggressive treatment protocol is the key for a good outcome.

Publication types

  • Case Reports

MeSH terms

  • Aspergillosis / complications
  • Aspergillosis / diagnosis
  • Bronchoscopy
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / diagnosis
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hemorrhage / etiology*
  • Humans
  • Liver Transplantation / adverse effects*
  • Lung Diseases / etiology
  • Lung Diseases / microbiology
  • Middle Aged
  • Pneumocystis Infections / complications
  • Pneumocystis Infections / diagnosis
  • Pneumocystis carinii
  • Pneumonia / complications*
  • Pneumonia / microbiology
  • Pulmonary Alveoli / pathology